1. warmer core 37 o C

2. perpheral (skin) thermoreceptors central thermoreceptors hypotalamus, spinal cord centre of thermoregulation hypotalamus ANS - sympathicus somatomotor NS brown adipose tissue vazomotor activity sweat glands muscle activity muscle shivering metabolism TSH-RH TSH T3, T4

3. Mechanisms of heat production metabolism skeletal muscle tone muscle shivering chemical thermogenesis in brown adipose tissue And helping vasoconstriction – heat saving voluntary mechanisms - behaviour

4. radiation conduction convection evaporation And helping vasodilation Mechanisms of heat loss 20 o C 30 o C 36 o C radiation61% 46% 0% convection26% 27% 0% evaporation13% 27%100%

5. Fever stages prodromal stage stadium incrementi - temperature raise stadium acme – culmination of fever stadium decrementi – decrease of temperature

6. Fever – prodromal stage endogenous pyrogens IL-1, IL-6, TNF exogenous pyrogens lipopolysaccharides hypotalamic thermostat arachidonic acid PGE 2 ASA ibuprofen cyclooxygenase increased set point

7. Stadium incrementi increase of heat production and saving of heat vasoconstriction – white, cold skin higher muscle tone muscle shivering behaviour – warm dress, warm covers

8. Stadium acme body temperature is maintained at the new level until the fever breaks. endogenous antipyretics –arginine vasopressin –melanocyte-stimulating hormone –ACTH-RH exogenous antipyretics –acetylsalicylic acid return the set point to normal

9. Stadium decrementi decrease of heat production and heat loss vasodilation sweating

10. Difference between fever and hypertermia 37 38 39 Hypertermia set point real temperature thermoregulation failure

11. Difference between fever and hypertermia 37 38 39 Fever real temperature set point thermoregulation failure NO! normal thermoregulation

12. Classification of fever Intensity subfebrility + 0,5 o C middle fever+ 2 o C high fever+ 3 o C very high fever + > 3 o C

13. febris atypica fever in the morning (typhus abdominalis) Classification of fever febris continua ( pneumonia) febris remittens (infective endocarditis) febris intermittens alternation of febrile and nonfebrile periods (sepsis) undulant fever (brucellosis) febris recurrens return of fever (malaria)

14. Classification of fever Length febris ephemera1 day febris acuta febris chronica

15. Benefits of fever kills thermolabile microorganisms it has adverse effects on growth and replication of some microorganisms decrease of serum level concentration of iron, zinc, copper which are needed for some microorganism lysosomal breakdown effect on phagocytosis production of antiviral interferon